U.S. patent number 6,972,017 [Application Number 10/345,519] was granted by the patent office on 2005-12-06 for polypectomy snare having ability to actuate through tortuous path.
This patent grant is currently assigned to SciMed Life Systems, Inc.. Invention is credited to Sean McBrayer, Kevin W. Smith.
United States Patent |
6,972,017 |
Smith , et al. |
December 6, 2005 |
**Please see images for:
( Certificate of Correction ) ** |
Polypectomy snare having ability to actuate through tortuous
path
Abstract
This invention relates broadly to surgical instruments. More
particularly, this invention relates to a surgical snare instrument
for excising polyps. Preferably, the instrument includes a coupling
member that may increase ability to actuate the snare. According to
a preferred embodiment, the present invention comprises a surgical
instrument for insertion through an endoscope having a handle and a
working channel, said surgical instrument including an elongate
flexible tubular sheath having proximal and distal ends; a flexible
shaft extending through and axially movable relative to the sheath,
said shaft having proximal and distal ends; an end effector coupled
to or formed at said distal end of said shaft; and a coupling
member disposed at said distal end of said shaft.
Inventors: |
Smith; Kevin W. (Coral Gables,
FL), McBrayer; Sean (Miami, FL) |
Assignee: |
SciMed Life Systems, Inc.
(Maple Grove, MN)
|
Family
ID: |
23456655 |
Appl.
No.: |
10/345,519 |
Filed: |
January 16, 2003 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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716776 |
Nov 20, 2000 |
6517539 |
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369724 |
Aug 6, 1999 |
6235026 |
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Current U.S.
Class: |
606/47;
606/113 |
Current CPC
Class: |
A61B
17/2909 (20130101); A61B 17/32056 (20130101); A61B
18/14 (20130101); A61B 17/221 (20130101); A61B
2017/2212 (20130101); A61B 2017/2929 (20130101); A61B
2017/293 (20130101); A61B 2018/00196 (20130101); A61B
2018/0091 (20130101); A61B 2018/1407 (20130101); A61B
2018/141 (20130101); A61B 2018/1861 (20130101); A61B
18/1492 (20130101) |
Current International
Class: |
A61B 018/18 () |
Field of
Search: |
;606/46,47,110,113,114 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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28 29 159 |
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Jan 1980 |
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DE |
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36 16 193 |
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Nov 1986 |
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DE |
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199 53 359 |
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May 2000 |
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DE |
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WO 92/22254 |
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Dec 1992 |
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WO |
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WO 00/42926 |
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Jul 2000 |
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WO |
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WO 00/53107 |
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Sep 2000 |
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WO |
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WO 01/10321 |
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Feb 2001 |
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WO |
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Other References
Product Brochure, "Trio 14, Re-engineering Over-the-Wire Balloon
Technology," 1994, 4 pages..
|
Primary Examiner: Peffley; Michael
Attorney, Agent or Firm: Crompton, Seager & Tufte,
LLC
Parent Case Text
CROSS REFERENCE TO CO-PENDING APPLICATIONS
This application is a continuation of U.S. application Ser. No.
09/716,776, filed Nov. 20, 2000 now U.S. Pat. No. 6,517,539; which
is a continuation-in-part of U.S. patent application Ser. No.
09/369,724, filed Aug. 6, 1999, U.S. Pat. No. 6,235,026 entitled
Polypectomy Snare Instrument, the disclosure of which is hereby
incorporated by reference.
Claims
What is claimed is:
1. A medical device, comprising: a tubular sheath having a lumen
extending therethrough; a shaft slidably disposed in the lumen, the
shaft including a proximal end and a distal end; an end effector
disposed adjacent the distal end of the shaft and coupled to the
shaft by a crimp band; and a coupling member coupled to the shaft
and disposed proximally of the crimp band.
2. The medical device of claim 1, further comprising a first handle
assembly for rotating the shaft relative to the sheath, and a
second handle assembly for longitudinally moving the shaft relative
to the sheath.
3. The medical device of claim 1, wherein the end effector
comprises a snare loop.
4. The medical device of claim 1, wherein the coupling member
comprises a shrink tube.
5. A medical device, comprising: a tubular sheath having a lumen
extending therethrough and an inside diameter; a shaft disposed in
the lumen; an end effector coupled to the shaft by a crimp band; a
coupling member coupled to the shaft and disposed adjacent the
crimp band, the coupling member having an outside diameter; and
wherein the inside diameter of the sheath and the outside diameter
of the coupling member are substantially equal so as to increase
the ability to actuate the end effector.
6. The medical device of claim 5, further comprising a first handle
assembly for rotating the shaft relative to the sheath, and a
second handle assembly for longitudinally moving the shaft relative
to the sheath.
7. The medical device of claim 5, wherein the end effector
comprises a snare loop.
8. The medical device of claim 5, wherein the coupling member
comprises a shrink tube.
9. The medical device of claim 5, wherein the coupling member is
disposed over the crimp band.
10. The medical device of claim 5, wherein the coupling member is
proximal of the crimp band.
11. The medical device of claim 5, wherein at least a portion of
the coupling member is disposed within the sheath.
12. A medical device, comprising: a tubular sheath having a lumen
extending therethrough; a shaft disposed in the lumen; an end
effector coupled to the shaft by a crimp band; wherein the end
effector is configured to shift between a first closed position
wherein at least a portion of the end effector is disposed within
the sheath and a second open position wherein the end effector is
disposed distally of a distal end of the sheath; a coupling member
coupled to the shaft and disposed adjacent the crimp band; and
wherein at least a portion of the coupling member is disposed
within the sheath when the end effector is in the second open
position.
13. The medical device of claim 12, further comprising a first
handle assembly for rotating the shaft relative to the sheath, and
a second handle assembly for longitudinally moving the shaft
relative to the sheath.
14. The medical device of claim 12, wherein the end effector
comprises a snare loop.
15. The medical device of claim 12, wherein the coupling member
comprises a shrink tube.
16. The medical device of claim 12, wherein the coupling member is
disposed over the crimp band.
17. The medical device of claim 12, wherein the coupling member is
proximal of the crimp band.
18. A medical devices, comprising: a tubular sheath having a lumen
extending therethrough; a shaft disposed in the lumen; a first
handle assembly for rotating the shaft relative to the sheath; a
second handle assembly for longitudinally moving the shaft relative
to the sheath; a snare coupled to the shaft by a crimp band; and a
shrink tube coupled to the shaft and disposed adjacent the crimp
band, the shrink tube being arranged and configured to increase the
ability to actuate the snare.
19. A medical device, comprising: a flexible tubular sheath having
a lumen extending therethrough; a shaft disposed in the lumen, the
shaft being rotatable and longitudinally moveable within the
sheath; a first assembly for rotating the shaft relative to the
sheath; a second assembly for longitudinally moving the shaft
relative to the sheath; a snare coupled to the shaft by a crimp
band; and a coupling member coupled to the shaft and disposed
adjacent the crimp band and within the lumen of the sheath.
20. The medical device of claim 19, wherein the coupling member
comprises a shrink tube.
21. The medical device of claim 19, wherein the coupling member is
disposed over the crimp band.
22. The medical device of claim 19, wherein the coupling member is
disposed proximally of the crimp band.
Description
FIELD OF THE INVENTION
This invention relates broadly to surgical instruments. More
particularly, this invention relates to a surgical snare instrument
for excising polyps. Preferably, the instrument includes a coupling
member that may increase the ability to actuate the snare.
BACKGROUND OF THE INVENTION
Polypectomy snare instruments are used for the endoscopic removal
of hypertrophic tissue growths within a body cavity, and
particularly within the colon. Polypectomy snare instruments
generally include an elongate tubular member, such as a catheter
sheath, a shaft extending through the tubular member, an elastic
wire forming a snare (loop) at the distal end of the shaft, and a
handle for moving the shaft distally and proximally within the
tubular member. The snare can be opened by moving the snare beyond
the distal end of the sheath, and closed by retraction of the snare
into the tubular member, each affected by movement of the shaft
relative to the sheath.
In operation, a physician introduces the distal end of the
instrument, with the snare of the snare instrument in a retracted
position, through the working channel of an endoscope until the
sheath begins to extend out of the distal end of the endoscope. The
physician then directs an assistant, who has control of the handle
of the snare instrument, to open the snare. The assistant
accomplishes this function by moving two portions of the handle
relative to each other. The physician then advances and retracts
the sheath into and out of the endoscope, while applying torque to
some portion of the instrument to position the snare loop over and
around a polyp. Once the snare loop is positioned around the polyp,
the physician orders the assistant to close the snare around the
polyp. Then, the physician or assistant energizes a source of
electrocautery current coupled to the shaft to desiccate, sever,
and cauterize the polyp. Finally, the polyp is removed by
withdrawing the snare (or, in some cases, the polyp is retrieved by
use of another instrument such as a biopsy forceps). In a variation
of the procedure, the physician uses suction applied to a channel
of the endoscope to remove the polyp or to hold it to the end of
the endoscope.
Prior art snare instruments have several problems. First, it is
difficult for the physician to precisely position the snare because
the physician relies on gripping the small, slippery sheath over
the shaft near where the sheath enters the endoscope handle.
Typically, it is necessary for the physician to repeatedly push,
pull, and torque the sheath and the shaft of the instrument in
order to achieve the desired position with the snare around the
polyp. Second, the prior art instruments are not capable of
efficient steering, because the shaft which is generally used is a
cable having low torsional stiffness, and is not usually free of
camber or "set". The result of these defects is that when the
instrument is used in a tightly-flexed endoscope, the distal end of
the snare does not respond directly to torsional input on the shaft
where it enters the endoscope handle; i.e., rather than directly
responding to torsional input from the physician, the shaft stores
the torsional force and upon reaching a threshold, uncontrollable
rotationally whips to release the force. Third, while several
attempts have been made at providing a snare instrument with a
handle adapted to more adeptly steer the snare, most of such prior
art instruments do not specifically allow for rotating the snare to
position it relative to the polyp. Rather, the physician must
rotate the shaft of the instrument by tightly gripping and rotating
the sheath where it enters the endoscope to try to maneuver the
snare over the polyp. In addition, in the several prior art devices
specifically adapted for rotational control, e.g., U.S. Pat. No.
5,066,295 to Kozak et al. and U.S. Pat. Nos. 3,955,587; 4,256,113;
and 4,294,254 to Chamness et al., the rotational control function
is placed in the handle at the proximal end of the instrument. This
handle then controls the extension and retraction of the snare loop
as well as the rotation of the snare loop. However, this handle is
typically held by the assistant, so the physician must orally
direct the assistant to coordinate the handle controls while the
physician moves the jacket in and out of the endoscope. As a
result, these instruments have not been widely accepted by
physicians.
SUMMARY OF THE INVENTION
The invention provides a snare instrument which permits the
physician to control all aspects of positioning the snare loop
relative to the polyp, while allowing the assistant to perform the
cauterizing and severing of the polyp. The snare instrument
provides the physician the means for advancing and retracting the
distal end of the snare instrument through the endoscope, as well
as rotating the snare, and provides the assistant the means for
extending and retracting the snare loop from the sheath of the
snare instrument.
As described in detail below, a surgical snare instrument is
provided. The snare instrument includes an elongate flexible
tubular sheath, a flexible shaft extending through and axially
movable relative to the sheath, a snare coupled to or formed at the
distal end of the shaft, and a system to move the shaft, and
consequently the snare, relative to the sheath. According to
several embodiments of the invention, the system for moving the
shaft relative to the sheath includes a first (physician's) handle
capable of controlling the position of the snare, and a second
(assistant's) handle proximal the first handle and adapted to
control contraction of the snare and cauterization. The handles are
coupled by a tubular sheath extension.
The physician's handle is preferably positioned along the sheath of
the snare instrument so that it is a few inches proximal to the
entry port of the endoscope handle when the distal end of the
sheath is adjacent to the distal end of an endoscope. The
physician's handle serves as a grippable element on the sheath and
contains a rotating means for rotating the shaft, so that when the
physician grips that handle the physician is capable of steering
(rotating) the snare by operating the rotating means. In addition,
the physician is also capable of positioning the entire sheath
relative to the endoscope by sliding the sheath into and out of the
working channel of the endoscope. The proximal handle is operable
by an assistant and permits longitudinal movement of the shaft and
snare and the application of a cautery current to the shaft and
snare.
According to other embodiments, the snare instrument is provided
with a connector which enables the snare instrument to be fixed
relative to an endoscope handle. Additionally, an embodiment is
also provided in which a single handle provides a physician with
means for advancing and retracting the sheath of the snare
instrument relative to the distal end of the endoscope, means for
actuating or advancing (opening) and retracting (closing) the snare
relative to the distal end of the sheath, and means for steering
(rotating) the snare to position the snare over a polyp. Since the
physician has direct and immediate control of the entire
instrument, the snare instrument obviates the need for an assistant
during the procedure, and improves the speed and efficiency of the
polypectomy procedure.
In a preferred embodiment, the snare is coupled to or formed at the
distal end of the shaft. Preferably, the snare is coupled to the
shaft by a crimp band. In an exemplary embodiment a coupling
member, for example a shrink tube, is disposed at the distal end of
the shaft. The coupling member can be, for example, adhered to the
shaft over the crimp band so that when the snare is actuated (e.g.,
retracted), the coupling member forms a gentle transition between
the outer diameter of the shaft and the inner diameter of the
sheath. Preferably, the coupling member increases the ability to
actuate an end effector, for example, a snare. In an alternate
embodiment, the coupling member can be adhered to the shaft just
proximal of the crimp band so as to minimize the step in diameter
when the snare is retracted.
Additional objects and advantages of the invention will become
apparent to those skilled in the art upon reference to the detailed
description taken in conjunction with the provided figures.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a broken side elevation in section of a first embodiment
of a snare instrument according to the invention;
FIG. 2 is an enlarged cross-section taken through line 2--2 in FIG.
1;
FIG. 3 is an enlarged cross-section taken through line 3--3 in FIG.
1;
FIG. 4 is an enlarged cross-section taken through line 4--4 in FIG.
1;
FIG. 5 is a broken section view of a physician's handle assembly
according to the second embodiment of the snare instrument of the
invention;
FIG. 6 is an enlarged cross-section through line 6--6 in FIG. 5,
showing the engagement of a key in a knob shaft;
FIG. 7 is an enlarged cross-section through line 7--7 in FIG. 5, at
a location proximal of the key;
FIG. 8 is a broken section view of a third embodiment of the snare
instrument according to the invention;
FIG. 9 is an enlargement of the area between lines 9a--9a and
9b--9b in FIG. 8;
FIG. 10 is a broken section view of a fourth embodiment of the
snare instrument of the invention;
FIG. 11 is a broken section view of a fifth embodiment of the snare
instrument of the invention;
FIG. 12 is an enlarged view of a coupling member disposed at the
distal end of the shaft; and
FIG. 13 is an alternate enlarged view of a coupling member disposed
at the distal end of the shaft.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
Turning now to FIG. 1, a first embodiment of a surgical snare
instrument 10 according to the invention is shown. The snare
instrument 10 includes an elongate flexible tubular sheath 12
having a proximal end 14 and a distal end 16, a flexible shaft 18
having a proximal end 20 and a distal end 22 extending through and
axially movable relative to the sheath 12, a snare 24 coupled to or
formed at the distal end 22 of the shaft 18, preferably adjacent
the distal end 16 of the sheath 12, and first and second handle
assemblies 26, 28, respectively, for moving the shaft 18 relative
to the sheath 12.
The shaft 18 is preferably a high strength, straightened
(camber-free) stainless steel wire of high elastic limit. The shaft
18 is adapted to be bent through a tortuous path without permanent
deformation. In addition, since the shaft 18 is free of camber, it
is possible to precisely rotate the snare 24 by rotating the shaft
at any point along its length.
Referring now to FIGS. 1-3, the physician's handle assembly 26,
which is the more distal of the two handles, generally includes a
body 30 and a knob 32 mounted in the body 30 on bearings 33a, 33b
in a manner which permits the knob 32 to rotate coaxially relative
to the body. The body 30 includes a central bore 34 with one or
more apertures 35, a threaded distal end 36, and a threaded
proximal end 38. The sheath 12 of the snare instrument 10 is
connected to the threaded distal end 36 of the body 32, e.g., by
means of a flare-nut connection 42. Preferably, a stiffening sleeve
44 is provided over the sheath 12 at the connection 42. The knob 32
includes a non-circular bore 40, e.g., having the cross-sectional
shape of a square. The knob 32 (for reasons discussed below) is
preferably at least as long as the distance of movement required to
open and close the snare 24; i.e., the length of the snare when
compressed in the sheath 12. The apertures 35 provide access to the
knob 32, so that the knob 32 can be rotated relative to the body
30, e.g., by a physician.
A portion of the shaft 18 extending through the bore 40 of the knob
32 is provided with a key 46; that is, a spline element fixed on
and about the shaft 18 or, alternatively, rigidly and fixedly
interposed between two portions of the shaft. The key 46 preferably
has a rectangular shape but may have another non-circular shape.
The key 46 is slidably axially movable within the bore 40.
Therefore, the shaft 12 may be moved axially through the bore 40
(and that is why the length of the knob 32 is preferably at least
as long as the distance of movement required to open and close the
snare). However, when the knob 32 is rotated relative to the body
30, the key 46 within the bore 40 is rotated and, consequently, the
shaft 18 and snare 24 are rotated relative to the sheath 12.
The distal handle assembly 28 is preferably positioned
approximately 210 cm from the distal end 16 of the sheath 12 for a
snare instrument 10 designed to be inserted into a 200 cm
endoscope. Thus, the physician can grip the body 30 in a manner
which permits rotating the knob 32 relative to the body, and hence
the snare 24 relative to the sheath 12, while using the body 30 as
a grip to axially position the snare instrument 10 within the
working channel of an endoscope.
The shaft 18 extends out of the proximal end 38 of the body 30 to
the proximal handle assembly 28, or assistant handle. The proximal
handle assembly 28 preferably includes a stationary member 50 and a
spool member 52 slidable relative to the stationary member. The
stationary member 50 includes a longitudinal throughbore 56 which
the proximal end 20 of the shaft 18 extends, a transverse slot 58,
a proximal thumb ring 60, and a distal threaded connector 62. The
proximal end of the shaft 18 is preferably provided with a
conductive stiffening sleeve 64, and a cylindrical conductive
bearing 66 is coupled about the proximal end of the stiffening
sleeve 64. The spool member 62 includes a cross bar 68 which
extends through the transverse slot 58 to secure the spool member
52 on the stationary member 50. In addition, the spool member 62
preferably includes a cautery plug 70. The conductive bearing 66
extends through the cross bar 68 and a collar 74 secures the
bearing 66 in the cross bar 68 in a manner which permits the
conductive bearing to freely rotate within the cross bar 68. A
spring 72 extends between the cautery plug 70 and the conductive
bearing 66, and provides a contact between the plug 70 and the
bearing 66 regardless of the rotational position of the bearing 66.
Movement of the spool member 52 relative to the stationary member
50 causes the snare 24 to extend from and retract into the distal
end 16 of the sheath 12.
Referring to FIGS. 1 and 4, an electrically insulative extension
sheath 80 extends over the shaft 18 between the proximal end 38 of
the body 30 and the distal end 62 of the stationary member 50
coupled, e.g., via flare-nut connections 82, 84. Thus, there is a
continuous outer connection joining, yet spacing apart, the distal
handle assembly 26 and the proximal handle assembly 28. A
stiffening sleeve 86 is preferably provided over the extension
sheath 80 at the proximal end 38 of the body 30, and another
stiffening sleeve 88 is preferably provided over the extension
sheath 80 at the distal end 62 of the stationary member 50.
In use, the physician introduces the snare instrument 10 into the
endoscope (not shown), typically by means of a port in the
endoscope handle which communicates with the working channel of the
endoscope. Then, the physician gives the proximal assistant's
handle 28 to the assistant. The physician then grips the body 30 of
the distal physician's handle 26 of the snare instrument and uses
it to position the distal end 16 of the sheath 12 adjacent to the
polyp to be excised. The physician then instructs the assistant to
extend the snare, which is performed by moving the spool member 52
relative to the stationary member 50. The physician then uses the
distal handle 26 to simultaneously axially position and rotate the
snare over the polyp. Then, the physician instructs the assistant
to close the snare and sever the polyp, using cautery if desired.
In this manner, the physician controls the means of positioning the
snare onto the polyp, and the assistant controls the opening and
closing of the snare and the cauterization.
In the first embodiment, as discussed above, it will be appreciated
that the knob 32 is preferably at least as long as the distance of
movement needed to open and close the snare 24. However, turning
now to FIGS. 5-7, according to a second embodiment of a snare
instrument 110, the key 146 on the shaft 118 is made sufficiently
small in diameter such that it can pass partly into the bearings
190, 191 on the body 130 (which support the knob 132) and proximal
and distal ends 136, 138 of the body 130, or even into the sheath
112 and extension sheath 180, and their respective stiffening
sleeves. Accordingly, the knob 132 is provided with a hollow knob
shaft 192 having a non-circular bore 140 which rotatably engages
the key 146 on the instrument shaft 118. The knob shaft 192 extends
beyond the proximal and distal ends of the knob 132. The knob shaft
192 extends into bearings 190, 191 of the body 130 which allows the
knob 132 and knob shaft 192 to spin within the body 130. The knob
shaft 192 may optionally extend through the proximal and distal
ends 136, 138 of the body 130, into the sheath (on the distal end)
and into the extension sheath (on the proximal end). In this
manner, it is possible to achieve a large range of axial motion
(e.g., 3.5 inches) while having a knob 132 of much shorter
dimension (e.g., 1.25 inches). It should be noted that if the key
146 has a substantial length (e.g., 0.75 inch), the body 130 and
knob 132 can be made even shorter, since it is necessary for only a
portion of the key 146 to be engaged with the non-circular bore 140
of the knob shaft 192 at any time.
In addition, while the first embodiment describes a shaft 18 that
is monolithic and continuous from the snare 24 to the proximal
handle assembly 28, the shaft may alternatively be a composite
structure. Specifically, referring to FIGS. 8 and 9, according to a
third embodiment of the invention, the straightened,
torsionally-stiff, camber-free section of the shaft 218 need only
extend from the snare to the knob 232. A swivel joint 290 may be
interposed on the shaft 218 between the knob 232 and the proximal
handle assembly, and join the shaft 218 to a flexible or stiff
proximal shaft extension 292 which extends to the proximal handle
assembly. The proximal end 294 of the shaft 218 is preferably
formed into an enlarged section, i.e., a head 296, or a separate,
enlarged head may be attached to the proximal end of the shaft. A
swivel tube 298, preferably made of a malleable alloy, Such as
brass or stainless steel, is provided over the head 296. A distal
end 299 of the swivel tube 298 is swaged or crimped to form a loose
fit on the shaft 218, while being small enough to retain the head
296. The swivel tube 298 is placed onto the shaft 218 such that the
head 296 is trapped inside the non-crimped portion 300 of the
swivel tube 298. The extension shaft 292 is pushed into the
proximal open end 304 of the swivel tube 298, and the swivel tube
298 is firmly crimped onto the extension shaft 292. The extension
shaft 292 is preferably made of either a flexible cable, for
example, a 1.times.7 stranded stainless steel cable preferably of
0.032-inch diameter, or a solid wire of a springy material such as
stainless steel, for example, a 0.020-inch diameter 304 stainless
steel spring-temper wire. The extension shaft 292 extends
proximally from the swivel tube 298 to the spool so that it
transmits reciprocating longitudinal motion of the spool through
the swivel tube 298 to the shaft 218.
This variation in constriction of the extension shaft 292 is
allowed because the purpose of the extension of the shaft 218 is
merely to transmit the reciprocating axial motion imparted by the
proximal handle; thus, if there exists a freely rotational joint
between distal shaft 218 and the extension shaft 292, there is no
requirement for the extension shaft to be straight,
torsionally-stiff, or camber-free.
Turning now to FIG. 10, according to a fourth embodiment of the
invention, the distal handle assembly 326 includes a mount 350
capable of firmly coupling the distal handle assembly 326 to a port
in an endoscope handle (not shown), for example, by interference
fit. In a preferred configuration, the mount 350 includes a
coupling fitting 352 which is couplable to the port of the
endoscope, and a connector 354 which is slidably movable, yet
capable of being secured in a position, relative to the coupling
fitting 352. The connector 354 has a proximal end 356 which is
threadably coupled to the distal end 336 of the body 330.
The coupling fitting 352 includes a cylindrical block 358 having an
axial bore 360, and a tubular nosepiece 362 secured in the axial
bore 360. The connector 354 includes a stepped bore 364 having a
relatively large central portion 366, and relatively smaller
proximal and distal portions 368, 370. The central portion 366 of
the stepped bore 364 is sized to permit relative axial movement
over the block 358. The distal portion 370 of the stepped bore 364
is sufficiently large to permit axial movement of the connector 354
over the nosepiece 362. A locking screw 372 extends radially into
the central portion 366 of the stepped bore 364 of the connector
354 such that the screw 372 may be rotated to tighten against the
block 358 to lock the connector 354 axially relative to the block.
The proximal end 314 of the sheath 312 extends through the
nosepiece 362 and block 358 and is fixedly coupled in the proximal
portion 368 of the stepped bore 364. Other aspects of the fourth
embodiment are substantially as described above with respect to the
first embodiment.
In use, the snare instrument is inserted through a port of an
endoscope until the nosepiece 362 of the snare instrument is stably
inserted in the port. The distal end of the sheath of the snare
instrument may then be adjustably fixed relative the distal end of
the endoscope by adjusting the connector 354 (and hence the handle
326, shaft 318, and sheath 312) over the block 358. When the sheath
is correctly positioned, screw 372 may be set. The distal handle
326 may then be operated, as described with respect to the first
embodiment, to rotate the shaft 318 and snare relative to the
sheath 312. Likewise, a proximal handle assembly, as described with
respect to the first embodiment, may then be manipulated to
longitudinally move the shaft 318 to open and close the snare (the
sheath having been previously set in position). With the
above-described embodiment, it may be possible for the physician to
operate without an assistant as the axial placement of the snare
instrument is established and set prior to rotation and activation
of the snare loop.
Referring now to FIG. 11, according to a fifth embodiment of the
invention, a single handle assembly 427 capable of being fixed
relative to an endoscope handle is provided. The handle assembly
427 of the snare instrument includes all of the controls previously
provided in the proximal and distal handle assemblies, and is
substantially similar to the distal handle assembly 326, described
above, with the additional incorporation of the snare opening and
closing functions. To that effect, a sliding spool assembly 428 for
longitudinally moving the shaft 418 relative to the sheath 412 may
be substantially rigidly fixed to the proximal end 438 of the body
430. For example, a distal end 462 of a stationary member 450 of
the spool assembly 428 may be threadably mated with the proximal
end 438 of the body 430. The spool assembly is preferably otherwise
substantially as described with respect to proximal handle assembly
28 of the first embodiment of the invention.
Referring now to FIG. 12, the snare instrument 10 includes an
elongate flexible tubular sheath 12 having a distal end 16, a
flexible shaft 18 having a distal end 22 extending through and
axially movable relative to the sheath 12, a snare 24 coupled to or
formed at the distal end 22 of the shaft 18, preferably adjacent
the distal end 16 of the sheath 12. In a preferred embodiment, a
snare 24 can be coupled to the distal end 22 of the shaft 18 by a
crimp band 96. Preferably, a coupling member 100 can be disposed at
the distal end 22 of the shaft 18. In an exemplary embodiment, a
coupling member 100 can be disposed over crimp band 96.
In a preferred embodiment, the coupling member 100 may comprise a
shrink tube. In an exemplary embodiment, the coupling member 100
may have an outside diameter appropriate for fitting inside the
sheath. Preferably, the coupling member 100 provides an increased
ability to actuate an end effector, for example a snare 24.
Referring now to FIG. 13, the snare instrument 10 includes an
elongate flexible tubular sheath 12 having a distal end 16, a
flexible shaft 18 having a distal end 22 extending through and
axially movable relative to the sheath 12, a snare 24 coupled to or
formed at the distal end 22 of the shaft 18, preferably adjacent
the distal end 16 of the sheath 12. In a preferred embodiment, a
snare 24 can be coupled to the distal end 22 of the shaft 18 by a
crimp band 96. In an exemplary embodiment, crimp band 96 comprises
a proximal end 98. Preferably, a coupling member 200 can be
disposed at the distal end 22 of the shaft 18. In an exemplary
embodiment, a coupling member 200 can be disposed proximal of the
crimp band 96, for example just proximal of the proximal end 98 of
the crimp band 96.
In a preferred embodiment, the coupling member 200 may comprise a
shrink tube. In an exemplary embodiment, the coupling member 200
may have an outside diameter appropriate for fitting inside the
sheath. Preferably, the coupling member 200 provides an increased
ability to actuate an end effector, for example a snare 24.
The resulting device is fixedly couplable relative to an endoscopic
handle and provides to the physician the following controls: a
means for controllably advancing, retracting, and setting the
sheath of the snare instrument relative to the distal end of the
endoscope; a means for advancing (opening) and retracting (closing)
the snare relative to the distal end of the sheath; and a means for
steering (rotating) the snare to position the snare over a polyp.
Since the physician has direct and immediate control of the entire
instrument, the snare instrument obviates the need for an assistant
during the procedure, and improves the speed and efficiency of the
procedure.
There have been described and illustrated herein several
embodiments of a surgical snare instrument. While particular
embodiments of the invention have been described, it is not
intended that the invention be limited thereto, as it is intended
that the invention be as broad in scope as the art will allow and
that the specification be read likewise. Thus, while the use of
particular monolithic and composite shafts have been disclosed with
respect to a snare instrument, it will be appreciated that other
flexible shafts may also be provided. Also, while the cautery
connector has been shown on the proximal handle, it will be
appreciated that the cautery connection may be provided in the
physician's handle, or elsewhere along the length of the device,
provided that the cautery connection will not interfere with the
axial longitudinal and rotating motions of the shaft. Furthermore,
while particular shapes and configurations have been described with
respect to the proximal and distal handles, it will be appreciated
that other shapes and configurations may be provided therefor. As
such, it will also be appreciated that other configurations which
provide a gripping handle for the sheath, means for rotating the
shaft, and means for longitudinally moving the shaft may be used.
For example, a control knob which rotates about an axis
perpendicular to the axis of the shaft via a right-angle drive
(using two meshing bevel gears) may be used to rotate the shaft.
The gears may be configured to permit step-up or step-down
rotation, for example, such that rotation of the shaft rotates the
shaft twice as much or one-half as much. In addition, levers,
gears, friction wheels, pulleys, links, etc., may be used to
longitudinally move the shaft within the sheath, and the snare
relative to the distal end of the sheath. Moreover, while a
particular nosepiece has been described for use in the fourth and
fifth embodiment, it will be appreciated that other nosepieces
enabling stable coupling of the snare handle to an endoscope handle
may be used. For example, a threaded connector capable of threading
into or over a port on the endoscope handle may be used. Also, in
the fourth and fifth embodiment, the mount and the body may be
integrally formed or molded, and in the fifth embodiment, the body
and the proximal sliding spool assembly may be integrally formed or
molded. In addition, it will be appreciated that aspects of the
various embodiments may be combined. For example, but not by way of
limitation, the key of the second embodiment or the swivel joint of
the third embodiment may be used in either of the fourth and fifth
embodiments. Furthermore, the described handle assemblies may be
used with other surgical instruments where both axial and
rotational movement of a control member relative to a tubular
member is required. For example, the handle may be used in
laparoscopic and endoscopic instruments, generally, which include
an end effector other than a snare loop. For example, and not by
way of limitation, end effectors such as baskets and forceps may be
used with the handle. It will therefore be appreciated by those
skilled in the art that yet other modifications could be made to
the provided invention without deviating from its spirit and scope
as claimed.
Numerous advantages of the invention covered by this document have
been set forth in the foregoing description. It will be understood,
however, that this disclosure is, in many respects, only
illustrative. Changes may be made in details, particularly in
matters of shape, size, and arrangement of steps without exceeding
the scope of the invention. The invention's scope is, of course,
defined in the language in which the appended claims are
expressed.
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